Provider Demographics
NPI:1669781258
Name:SENIORS IN SERVICE OF TAMPA BAY, INC.
Entity type:Organization
Organization Name:SENIORS IN SERVICE OF TAMPA BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PUTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-932-5228
Mailing Address - Street 1:1306 W. SLIGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5902
Mailing Address - Country:US
Mailing Address - Phone:813-932-5228
Mailing Address - Fax:813-932-9604
Practice Address - Street 1:1306 W. SLIGH AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5902
Practice Address - Country:US
Practice Address - Phone:813-932-5228
Practice Address - Fax:813-932-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5776372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL672457400Medicaid